RESUMO
Early diagnosis of basilar artery occlusion (BAO) based only on clinical findings is challenging. We present a fully recovered case of BAO caused by pulmonary arteriovenous malformation (PAVM) that was diagnosed early using a protocol for CT angiography (CTA) and promptly treated with endovascular therapy (EVT). A woman in her 50s complained of vertigo with normal level of consciousness (LOC). On arrival, her LOC decreased to a Grass Coma Scale score of 12, and we performed a CT chest-cerebral angiography protocol. Head CTA showed BAO, and an intravenous tissue plasminogen activator was administered, followed by EVT. Chest contrast-enhanced CT showed PAVM in segment 10 of the left lung, which was treated with coil embolisation. For patients with a complaint of vertigo, BAO should be suspected, even if they have an initially normal LOC. A CT chest-cerebral angiography protocol is useful for prompt diagnosis and treatment of BAO and can reveal undetermined causes.
Assuntos
Arteriopatias Oclusivas , Malformações Arteriovenosas , Insuficiência Vertebrobasilar , Feminino , Humanos , Artéria Basilar , Ativador de Plasminogênio Tecidual/uso terapêutico , Insuficiência Vertebrobasilar/tratamento farmacológico , Angiografia Cerebral/métodos , Arteriopatias Oclusivas/tratamento farmacológico , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Tomografia Computadorizada por Raios XAssuntos
Antibacterianos/uso terapêutico , Infecções por Klebsiella/microbiologia , Embolia Pulmonar/microbiologia , Sepse/microbiologia , Tromboflebite/microbiologia , Idoso , Dor nas Costas , Eletrocardiografia , Febre , Humanos , Infecções por Klebsiella/complicações , Infecções por Klebsiella/tratamento farmacológico , Masculino , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Sepse/complicações , Sepse/tratamento farmacológico , Tromboflebite/complicações , Tromboflebite/tratamento farmacológico , Resultado do TratamentoAssuntos
Dor Abdominal/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Artérias Mesentéricas/patologia , Tomografia Computadorizada por Raios X , Dor Abdominal/etiologia , Dor Abdominal/terapia , Dissecção Aórtica/complicações , Dissecção Aórtica/terapia , Serviço Hospitalar de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Case: A 51-year-old woman visited our emergency department complaining of acute onset of upper abdominal pain and nausea. Abdominal contrast-enhanced computed tomography showed an isolated left gastric artery dissection and pseudoaneurysm. After conservative management for 6 days, endovascular embolization was carried out for treatment of the pseudoaneurysm. Spontaneous dissection of a visceral artery rarely occurs in the case of a left gastric artery. Outcome: Contrast-enhanced computed tomography is essential to make an accurate diagnosis and establish a therapeutic strategy. Conclusion: We should consider the occurrence of minor visceral artery dissection if a patient has acute abdominal pain without other obvious causes.
